Obsessive Compulsive Disorder Decision Tree case study essay
You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment
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Obsessive Compulsive Disorder was chosen for the diagnosis in Decision 1
Begin Fluvoxamine immediate release 25mg orally at bedtime was chosen for Decision 2
Augment therapy with cognative behavior therapy was chosen for Decision 3
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Decision #1: Differential Diagnosis
Which Decision did you select?
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Obsessive Compulsive Disorder Decision Tree case study essay
Resources. Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision.
Why were they different?
Decision #2: Treatment Plan for Psychotherapy
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning
Resources. Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision.
Why were they different?
Decision #3: Treatment Plan for Psychopharmacology
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning
Resources. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision.
Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients and their families.
Assessing and Treating Pediatric Clients
Introduction
The case study is on an 8-year-old boy, manifesting psychiatric symptoms. The mother reported that the client had become very nervous and worried. He also spends most of the time cleaning his hand because he fears his hands could get contaminated and become sick like he previously did. The client has also been avoiding playing with his friend and attending school. Other symptoms include irritability and sleep problems. Accordingly, this assignment involves making decisions about the diagnosis for the client and treatment choices. The paper will conclude by discussing ethical aspects likely to impact the treatment of the client.
Decision Point One
According to the presented symptoms for this client, the decision regarding the diagnosis of the client is that he has obsessive-compulsive disorder (OCD). The reason why this decision was selected is that he presents symptoms akin to OCD symptoms. According to the DSM-5 criteria, symptoms of OCD include repetitive ritualized behaviors and intrusive obsessions. The symptoms of OCD lead to anxiety and distress to the client (Sachs & Eefurth, 2018). Examples of compulsions in people with OCD consist hand washing, avoidance, routine praying, routinized behaviors, among other behaviors (Sachs & Eefurth, 2018). In this case study, the client manifests anxiety and the ritualistic compulsive behavior include handwashing.
The intrusive obsession presented by this client is his fear of his hand becoming contaminated with germs and as a result, becoming sick (Sachs & Eefurth, 2018). Nonetheless, the client may also be having social phobia as manifested by his school avoidance and avoiding socializing with his friends. Obsessive Compulsive Disorder Decision Tree case study essay.
Decision Point Two
The second decision for this client is to begin Fluvoxamine immediate release 25 mg orally at bedtime. The reason why this medication was chosen is that it is an SSRI and it is FDA approved for children who are 8-years and above (Pittenger & Bloch, 2014). The medication works by hindering the reuptake of serotonin within the brain. Additionally, evidence has demonstrated the efficacy of Fluvoxamine in treatment of OCD in children by improving the symptoms. In addition, the medication has been shown to be tolerable and safe for pediatric population. Because fluvoxamine has sigma-1 antagonist effects and thus causes sedation, it is supposed to be administered during bedtime (Thamby & Jaisoorya, 2019) Obsessive Compulsive Disorder Decision Tree case study essay.
Selection of this decision hoped that the OCD symptoms in the client would decrease. This can be manifested by reduced handwashing and reduced fear of contamination as well as reduced anxiety. This is because the efficacy of the drug has been demonstrated in treatment of OCD in children (Pittenger & Bloch, 2014). Secondly, it was hoped that the client would tolerate the drug and thus not have any adverse side effect.
The result of this decision was just as it was expected because there was a decrease in the symptoms in the client in the client as the handwashing reduced and anxiety as well. The sociability of the client also improved as he began interacting with his friend. The symptom improvement in this client is attributable to the efficacy of fluvoxamine in improving symptoms of OCD (Thamby & Jaisoorya, 2019). In addition, the client did not report any side effects from the medication.
Decision Point Three
The chosen third decision was for the client to augment the treatment using cognitive behavior therapy. The reason for this choice is because CBT has been demonstrated to be effective when treating OCD and the therapy does not carry any side effects or risks (Wu et al, 2016). When treating OCD, cognitive behavior therapy uses exposure and response prevention (ERP) and cognitive therapy to alter the thoughts and behavior of an individual. During the step of exposure-response prevention (ERP), the person with OCD is kept in a situation likely to expose him/her to the obsessions and the client is advised not to conduct compulsions that they normally perform to ease the anxiety and distress (Tundo et al, 2016). In this case the client would be exposed to a contaminated area and requested not to perform hand-washing. After this, cognitive therapy is then applied where the therapist helps the client to alter the negative thinking pattern associated with the obsession and compulsive behavior (Tundo et al, 2016). The client is helped to identify the patterns that cause distress and negative behavior such as the compulsions and adopt a more adaptive thinking pattern and hence reduce the anxiety, distress, as well as the negative behavior associated with performing the compulsive acts (Wu et al, 2016) Obsessive Compulsive Disorder Decision Tree case study essay.
Ethical Considerations
The ethical considerations that could affect the client’s treatment plan include informed consent. Since medications such as Fluvoxamine is associated with specific side effects, it would be important to inform the parents of the client about the possible side effects as well as provide full information about all available treatment options to enable them to make an informed treatment choice (Pittenger & Bloch, 2014).
Conclusion
The client’s diagnosis is OCD because the client is obsessing with his hands becoming contaminated and performs compulsive behavior of ritualistic handwashing. The second decision is for the client to start client fluvoxamine immediate release 25 mg due to the medication’s efficacy in the treatment of OCD in children. the last decision is to augment the treatment with CBT due to its efficacy in lowering OCD symptoms. Lastly, the ethical consideration applicable for this client is informed consent to allow the parents make an informed treatment choice. Obsessive Compulsive Disorder Decision Tree case study essay.
References
Pittenger C & Bloch M. (2014). Pharmacological treatment of obsessive-compulsive disorder. Psychiatr Clin North Am. 37(3), 375–391.
Sachs G & Eefurth A. (2018). Obsessive Compulsive and Related Disorders: From the Biological Basis to a Rational Pharmacological Treatment. Int J Neuropsychopharmacology. 21(1), 59–62.
Thamby A & Jaisoorya T. (2019). Antipsychotic augmentation in the treatment of obsessive-compulsive disorder. Indian J Psychiatry. 61(Suppl 1), S51–S57.
Tundo A & Necci R. (2016). Cognitive-behavioral therapy for obsessive-compulsive disorder co-occurring with psychosis: Systematic review of evidence. World J Psychiatry. 6(4), 449–455.
Wu Y, Lang Z & Zhang H. (2016). Efficacy of Cognitive-Behavioral Therapy in Pediatric Obsessive-Compulsive Disorder: A Meta-Analysis. Med Sci Monit. 1(22), 1646–1653. Obsessive Compulsive Disorder Decision Tree case study essay